Pain in Motion International Research Group.
Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, 1090, Brussels, Belgium.
Support Care Cancer. 2019 Dec;27(12):4401-4433. doi: 10.1007/s00520-019-04936-5. Epub 2019 Jul 25.
Breast cancer remains the most frequently diagnosed malignancy among women worldwide, with rising incidence numbers. In Belgium, one out of eight women will be diagnosed with breast cancer. Fortunately, 80% of those breast cancer patients will still be alive 10 years after diagnosis due to improvements in screening and treatment strategies. However, an important portion of the breast cancer survivors (BCS) will face side effects, such as sleep disturbances, long after treatment ends. It has been demonstrated that untreated insomnia in BCS negatively impacts mood, physical symptoms, pain sensitivity, fatigue, and quality of life. Furthermore, insomnia is increasingly considered an independent risk factor for future depression in BCS. The importance of understanding sleep disturbances in cancer populations has been highlighted and recognized as warranting further research. Therefore, the purpose of this systematic review was to determine the prevalence and the risk factors for the development of sleep disturbances in BCS.
PubMed, Web of Science, and PEDro were systematically screened for studies encompassing data regarding the prevalence or risk factors of sleep disturbances in BCS. If possible, meta-analyses were performed. Subgroup analyses were undertaken based on the methodological quality, study design, type of sleep disturbance, and the use of a measurement tool with strong psychometric properties to investigate significant heterogeneity (I > 50%) across studies.
A total of 27 studies were found eligible. The pooled estimate for sleep disturbances prevalence is 0.40 (95% confidence interval (CI) = [0.29-0.52], I = 100%, p < 0.00001) and ranged from 0.14 (95% CI = [0.04-0.24]) to 0.93 (95% CI = [0.91-0.95]). Subgroup analyses did not reduce the heterogeneity among studies. Meta-analyses were performed for seven risk factors. Significant differences for the odds of developing sleep disturbances were found for hot flashes (pooled OR (OR) 2.25, 95% CI = [1.64-3.08], I = 0%, p = 0.90), race (OR 2.31, 95% CI = [1.56-3.42], I = 0%, p = 0.47), and menopause (OR 1.84, 95% CI = [1.11-3.06], I = 0%, p = 0.70). After withdrawing the studies that did not rely on the use of a measurement tool with strong psychometric properties, pain (OR 2.31, 95% CI = [1.36-3.92], I = 27%, p = 0.25), depressive symptoms (OR 3.20, 95% CI [2.32-4.42], I = 0%, p = 0.63), and fatigue (OR 2.82, 95% CI = [1.98-4.02], I = 0%, p = 0.60) became significant as well, with a substantial decrease of heterogeneity.
Prevalence for sleep disturbances ranged from 0.14 to 0.93 with the vast majority of the studies investigating insomnia and sleep-wake disturbances. High heterogeneity makes it difficult to draw firm conclusions. Pain, depressive symptoms, hot flashes, fatigue, non-Caucasian race, and menopausal status were significantly associated with increased odds for developing sleep disturbances.
乳腺癌仍然是全世界女性中最常见的恶性肿瘤，发病率呈上升趋势。在比利时，每 8 名女性中就有 1 人被诊断患有乳腺癌。幸运的是，由于筛查和治疗策略的改进，80%的乳腺癌患者在诊断后 10 年内仍能存活。然而，相当一部分乳腺癌幸存者（BCS）在治疗结束后很长一段时间内仍会出现睡眠障碍等副作用。研究表明，未经治疗的乳腺癌幸存者失眠会对情绪、身体症状、疼痛敏感度、疲劳和生活质量产生负面影响。此外，失眠越来越被认为是乳腺癌幸存者未来抑郁的一个独立危险因素。人们已经认识到了解癌症患者睡眠障碍的重要性，并认为这是值得进一步研究的。因此，本系统综述的目的是确定乳腺癌幸存者睡眠障碍的患病率和发病风险因素。
系统检索了 PubMed、Web of Science 和 PEDro，以获取有关乳腺癌幸存者睡眠障碍患病率或发病风险因素的研究数据。如果可能，进行了荟萃分析。根据方法学质量、研究设计、睡眠障碍类型以及使用具有较强心理测量特性的测量工具进行了亚组分析，以调查研究之间的显著异质性（I > 50%）。
共发现 27 项符合条件的研究。睡眠障碍的总患病率估计值为 0.40（95%置信区间（CI）= [0.29-0.52]，I = 100%，p < 0.00001），范围为 0.14（95% CI = [0.04-0.24]）至 0.93（95% CI = [0.91-0.95]）。亚组分析并未降低研究之间的异质性。对 7 个发病风险因素进行了荟萃分析。发现潮热（比值比（OR）2.25，95%置信区间（CI）= [1.64-3.08]，I = 0%，p = 0.90）、种族（OR 2.31，95% CI = [1.56-3.42]，I = 0%，p = 0.47）和绝经（OR 1.84，95% CI = [1.11-3.06]，I = 0%，p = 0.70）等风险因素与睡眠障碍的发生几率存在显著差异。在排除了未使用具有较强心理测量特性的测量工具的研究后，疼痛（OR 2.31，95% CI = [1.36-3.92]，I = 27%，p = 0.25）、抑郁症状（OR 3.20，95% CI [2.32-4.42]，I = 0%，p = 0.63）和疲劳（OR 2.82，95% CI = [1.98-4.02]，I = 0%，p = 0.60）也变得显著，且异质性显著降低。
睡眠障碍的患病率范围为 0.14 至 0.93，大多数研究都调查了失眠和睡眠-觉醒障碍。高度的异质性使得很难得出明确的结论。疼痛、抑郁症状、潮热、疲劳、非白种人种族和绝经状态与睡眠障碍发生几率的增加显著相关。
